sustainable, resilient, healthy people & places · world health organization definition the...

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Sustainable, Resilient, Healthy People & PlacesA Sustainable Development Strategy for the NHS, Public Health and Social Care system

Foreword

We all value our health and the places where we live and recognise that enabling individuals and communities to leadhealthy lives also means acknowledging the value of our environmental and social assets. Reducing carbon emissions andpreparing for extreme weather events can be achieved whilst protecting natural resources and strengthening social systems.This, in turn, can provide significant short term and priceless long term benefits for our health, communities and services.

Our NHS, public health and social care system is at an important crossroads. Whether we consider our demographics, ouruse of resources or the financial forecasts, it is widely accepted that the current health and care system is unsustainablewithout radical transformation. For the first time we are developing an approach to sustainability that embraces the entirehealth and care system, not just one part of it. Local government, public health, social care, professional bodies and NHScolleagues have contributed to and support this approach. We are clear that we need to work in partnership not onlywithin and across our organisations but also with our communities, to unleash the opportunities and benefits needed toimprove genuine health and wellbeing. Unless we make working sustainably a priority all our other priorities could beundermined.

The approach described in this strategy is the result of intensive engagement across the health and care system. It describesthe most important principles and opportunities that can be taken to enable a more sustainable health and care system overthe next five years. These align with the current policy direction for integrated care closer to home and we know this iswhat the public expects of us.

Our leadership will be tested in our commitment and ability to bring about the transformations required. We must takethese concepts forward in our lives, our jobs, our teams and organisations, and with our communities. We must do sopositively and inquisitively, with enthusiasm and with vigour. This agenda creates many positive benefits and it is alreadygenerating energy for change in people, organisations and communities. It also demonstrates our responsibility andcommitment to a broader and more global perspective of health and wellbeing.

Sustainable | Resilient | Healthy | People & Places2

ContentsForeword .............................................................................................2

Together we can .................................................................................3

Introduction .........................................................................................4

Vision and goals ..................................................................................5

A sustainable approach .......................................................................6

A modular approach ...........................................................................8

Diagram of strategy vision, goals and modules ...............................10

How to take this forward .................................................................11

What does success look like in 2020? ..............................................15

Context .............................................................................................16

The public’s views ..............................................................................17

The system’s views ............................................................................18

Carbon footprint of the NHS, Public Health and Social Care system ...............................................19

Executive summary ...........................................................................20

Contributors ......................................................................................22

Glossary .............................................................................................26

References .........................................................................................27

Sir David Nicholson CBE,Chief Executive, NHS England

Duncan Selbie,Chief Executive, Public Health England

A Sustainable Development Strategy for the NHS, Public Health and Social Care system

Together we can

Many organisations, individuals and communities across the health and care system are working together to deliver betteroutcomes for all and doing so by reflecting the principles of sustainable development. We are indebted for everyone’scontribution to the principles and proposals in this strategy. It is encouraging that so many organisations are choosing totransform the approach to health and care whilst minimising environmental impacts and improving social reach.

The following organisations have expressed their support for a more sustainable, resilient and healthy NHS, public healthand social care system:

3

Association of London Councils

Association of Directors ofPublic Health

Association of Directors ofAdult Social Services

Allied Health ProfessionsFederation

Chartered Institute of Environmental Health

Care Providers Alliance

British Medical Association

Academy of Medical RoyalColleges

Health & Social CareInformation Centre

NHS Confederation

Health Education England

Care Quality Commission

NHS Property Services

National Institute for Healthand Care Excellence

NHS England

Local Government Association

Royal College of Midwives Royal College of NursingPublic Health England

NHS Trust DevelopmentAuthority

NHS Alliance


"We need to develop a health and care system that is financially, socially andenvironmentally sustainable; that does not simply mean we must make the best use ofresources; it also means we must improve both the quality of life, and quality of care,experienced by all users of health and care services."

Stephen Dorrell - ChairHealth Select Committee

Introduction

The purpose of the health and care system is to continually improve health and wellbeing and deliverhigh quality care when necessary.

The challenge is how to do this now and for future generations within available financial, social andenvironmental resources. Understanding these challenges and developing plans to achieve improvedhealth and wellbeing and continued delivery of high quality care is the essence of sustainabledevelopment.

Current discussions, including the NHS Call to Action1, are exploring how to achieve the best possiblehealth and care outcomes within the financial resources available. As these discussions continue, it isequally important that we factor in:• The environmental impact of the health and care system and the potential health co-benefits of

minimising this impact• How the health and care system needs to adapt and react to climate change, including preparing and

responding to extreme events• How the NHS, public health and social care system maximises every opportunity to improve economic,

social and environmental sustainability.

This strategy outlines a vision and three goals based on the challenges outlined above to aim for by2020. It describes the opportunities to reduce our environmental impacts, improve our naturalenvironment, increase readiness for changing times and climates and strengthen social cohesion. It alsoexplores how this can be taken forward as a system and outlines specific areas of focus that can be usedto guide action.

The vision and goals have been developed following an extensive consultation and engagement processwith almost 1,000 responses covering all parts of the system. Engagement with the public alsodemonstrated there is an expectation that sustainable development should be part of the way the healthand care system works in the future. The development of the strategy has also greatly benefitted fromthe advice and assistance of the Department of Health, the Department for Environment Food & RuralAffairs (Defra) and the Department of Energy & Climate Change (DECC).

This strategy is intended to complement the discussions taking place across the NHS, public health andsocial care about future approaches to improving health and more integrated models of care.

A Sustainable Development Strategy for the NHS, Public Health and Social Care system 5

Goal 1: A healthier environmentA healthier environment can contribute to better outcomes for all. This involves

valuing and enhancing our natural resources, whilst also reducing harmful

pollution and significantly reducing carbon emissions. Contributing to the

Climate Change Act target with a 34% reduction in carbon emissions by 2020 is

a key measure of our ambition across the country.

Goal 2: Communities and services are ready and resilient for changing times andclimatesWhen periods of heat, cold, flooding and other extreme events occur it is

vulnerable people and communities that suffer the worst. Those communities

and their services bear the responsibility of addressing the consequences of these

events. Multi-agency planning and organisational collaboration, underpinned by

local plans and assurance mechanisms, provide a better solution to these events

than working independently, individually and ineffectively.

Goal 3: Every opportunity contributes to healthy lives, healthy communities andhealthy environmentsEvery contact and every decision taken across the health and care system can

help build the immediate and longer term benefits of helping people to be well

and reduce their care needs. There are multiple mechanisms that can support

this approach from improved information, more integrated approaches and

smarter more aligned incentives that help minimise preventable ill-health, health

inequalities and unnecessary treatment. A sustainable system cannot be

achieved without taking every opportunity to support communities and people

to be independent and self-manage conditions and events.

Vision & goals

Our vision of sustainable health and care: A sustainable health andcare system works within the available environmental and socialresources protecting and improving health now and for futuregenerations.

This means working to reduce carbon emissions, minimising waste &pollution, making the best use of scarce resources, building resilience toa changing climate and nurturing community strengths and assets.

“Health is a state of complete physical, mental and socialwellbeing and not merely the absence of disease or infirmity.”2

World Health Organization Definition

The system

The NHS, public health and social caresystem can be defined by its sharedprinciple purpose to increase health andwellbeing. It does this by treating thosein ill health, caring for those in need,and protecting and promoting thepublic’s health.

The system includes all those who sharethis purpose. In this strategy “the healthand care system” is used as short handfor this “NHS, public health and socialcare system”.


A sustainable approach

Helping to create sustainable, resilient, healthy places and people needs to be approached both by enabling thepositives and by reducing the negatives allowing virtuous cycles to constantly improve outcomes.

Enable the positives

By valuing our physical and social environment, we can restore

our natural environment and strengthen our social assets,

whilst enhancing our independence and wellbeing at both a

personal and community level. By doing so, we improve the

quality of care, build strong communities and generate

conditions where life is valued in ways that current

generations can be proud to pass on.

Reduce the negatives

By radically reducing the harmful impacts of how we currently

live we can stop wasting finite resources, reduce the burdens

of preventable mental and physical ill health, reduce social

inequalities and reduce risks from a changing climate. In

addition, many interventions that reduce harmful impacts also

promote positive co-benefits and reduce the burden of

disease.

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This document focuses on ensuring a strong, healthy andjust society living within environmental limits whilstrecognising that achieving a sustainable economy,promoting good governance and using sound scienceresponsibly are inherent pillars that support such a society.

The term sustainability refers to the wider concept asdescribed above and should not be confused with thenotion of financial affordability.

Houghton-le-Spring Primary Care Centre, Sunderland

This new-build primary care centre is a combination ofhealth and social care facilities linked to an existingsports and leisure facility with the City Council andNHS working together. An exemplary site for lowcarbon construction technologies, Houghton PrimaryCare Centre was the first healthcare project to achievea BREEAM ‘Outstanding’ rating. The new care centreaccommodates traditional healthcare services alongsideother services usually accessed through hospitals such asa minor injuries walk-in centre, a planned care anddiagnostics suite, a minor surgery treatment centre anda 24-bed rehabilitation unit. Located adjacent to aleisure centre the facility offers lots of exercise options,from skateboarding and a trim trail to games pitchesand bowling greens. A number of structural changes tothe building helped to reduce energy consumption withfeatures designed to cool the building in summer andheat efficiently in winter. The building supports a greenroof to encourage local biodiversity4.

Sustainable development aims andprinciples

Sustainable development aims to ensure the basicneeds and quality of life for everyone are met, nowand for future generations.

Its guiding principles are:• Ensuring a strong, healthy and just society• Living within environmental limits• Achieving a sustainable economy• Promoting good governance • Using sound science responsibly

From Sustainable Development in Government3

"Sustainability is a core component of the quality ofcare we deliver. I admire the NHS, public health andsocial care system in England for tackling theseissues and would encourage every service tointegrate these concepts into their workingpractices and every organisation to systematicallyidentify ways of doing so."

Don Berwick - Chief ExecutiveInstitute for Healthcare Improvement

To support the delivery of the vision and goals of this strategy a number of modules have been developed that focus onspecific key areas. Every module explores a different angle to help strengthen action within locally determined priorities.

These modules are available online on the Sustainable Development Unit website5 along with accompanyingimplementation guidance notes.

Leadership, engagement and developmentSustainable and resilient services will only emerge from a culture that understands and values environmental and socialresources alongside financial ones. Engagement at all levels with the public, service users, trade unions and staff canprovide the basis for positive action at every level. This module covers the following:• Leadership for sustainable health and care • Engagement• Developing a workforce fit for the future

Sustainable clinical and care modelsSustainable models of care can deliver better health and wellbeing by enhancing enabling and integrated approaches tocare, building resilience with individuals and their communities and reducing environmental impacts. This module coversthe following:• Sustainability as a factor underpinning high quality care • Transforming care

Healthy, sustainable and resilient communitiesStrong and healthy communities support people to minimise their impact on the environment and be resilient to changesin the world around us. Local level partnerships can be strengthened so they continue to help neighbourhoods flourish.Connected communities will be better prepared for environmental and climatic changes including the impacts of severeweather events such as heat waves, cold snaps, and flooding. This module covers the following: • Developing local frameworks• Building resilience to climate change and adverse events

Carbon hotspotsCarbon emissions are an important indicator of environmental impact. The health and care system carbon footprint hasidentified carbon hotspots that can be targeted to achieve significant reductions. This module covers the following three:• Pharmaceuticals, medical devices and gases• Energy • Travel and transport

Commissioning and procurementCommissioning of services and the procurement of products are very powerful levers to influence the delivery ofsustainable services. Commissioners can develop and use criteria to stimulate more ambitious and innovative approachesto delivering care that costs less, creates less environmental harm and reduces inequalities.

Equally, the significant procurement budget for goods and products used by the health and social care system providesmultiple opportunities to maximise social, economic and environmental value.This module covers the following:• Services: The specific role of social care, public health and NHS commissioners• Products: A whole lifecycle and responsible sourcing approach to procurement of goods

Sustainable | Resilient | Healthy | People & Places

A modular approach

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Further modulesThe further development of three modules are required to reflect the needs emerging from the system. These will beconsulted on during the summer of 2014 and published in January 2015. The three extra modules proposed are:• Innovation: This module summarises the key research themes in implementing a more sustainable health and care

sector. It will:- identify the opportunities and barriers to ensure the necessary research is performed and implemented- summarise the progress possible through technology and innovation

• An integrated metrics approach: This module will be developed by a cross system metrics steering group chaired byPublic Health England and convened by the Royal College of General Practitioners (RCGP). The module will consider thedata currently collected across different parts of the system and consider how best to highlight progress over time. Itwill:- highlight the existing data that can be used to inform progress on sustainable development- highlight measures that can be used across different parts of the system- recommend future requirements if necessary

• Building social capital as a core role of the health and care system: A working group will be established todevelop this module. It will pull together the latest thinking and emerging evidence that can contribute to fosteringsocial value. The module will:- provide a definition, vision and a framework for considering the role of social capital across the NHS, public health

and social care system- clarify how the health and care system can further develop social value within and between its own organisations

and communities


VIS

ION

GO

ALS

A sustainable health and care system works within the available environmental and social resources protecting and improving health now and for future generations.

This means working to reduce carbon emissions, minimising waste & pollution, making the best use of scarce resources, building resilience to a changing climate and nurturing community strengths and assets.

Localities and Health and Wellbeing Boards

GOAL 1: A healthier environment

GOAL 2: Communities and services are ready and resilient for changing times and climates

GOAL 3: Every opportunity contributes to healthy lives, healthy communities and healthy environments

Carbon hotspots Sustainable clinical and care

models

Healthy,sustainable

and resilientcommunities

Innovation

Commissioning andprocurement

Leadership, engagement

and development

Metrics Social capital

Organisations

MO

DU

LES

Jan 2015

Jan 2015Jan 2015

Diagram of strategy vision, goals and modules

The opportunities described in this strategy and itssupporting sections are likely to mean different mechanismsfor different parts of the health and care system. Theproposals below are highlighted as part of an integratedapproach to help support progress. Clearly everyorganisation and local system will want to consider whichapproach works best in their locality.

Sustainable development as a component of Healthand Wellbeing StrategiesHealth and Wellbeing Boards are well placed to take aleadership role in developing a strong and inspiring localvision for sustainability. They have a responsibility to act inthe interests of local people to improve health andwellbeing, local accountability, membership from across thehealth and care system and the ability to align and reinforceactivity. They can integrate issues that are core to thisagenda including the redirection of existing services toaddress issues such as the causes of ill-health, life styles,service infrastructure, models of care, health protection andresilience.

Health and Wellbeing Boards can choose to include localitybased sustainable development plans as part of their Healthand Wellbeing Strategies6 and could offer to publish ayearly progress report. A King’s Fund7 report has found thatmost Health and Wellbeing Boards have already begunadopting Marmot’s six policy objectives8, one of which is to“Create and develop healthy and sustainable places andcommunities”.

Joint Strategic Needs Assessments (JSNAs)6 for each arearepresent an ideal opportunity to consider how theprinciples of sustainable development can help deliver localpriorities. A guide to integrating sustainability into JSNAshas been developed by Kent County Council9.

Cross system national groupA cross system national group has been established and isworking to support sustainable development across theNHS, public health and social care system. This group ofrepresentative leaders monitors progress and looks foropportunities for highlighting best practice and considersthe barriers to development across the system. The groupis likely to publish regular reports of system-wide progressand successful approaches that can be replicated.


How to take this forward

Tackling fuel poverty andreducing winter deaths

Islington London Borough Council and NHS Islingtonare working together to reduce fuel poverty, seasonaldeaths and hospital admissions in winter through theSeasonal Health Interventions Network (SHINE).Theyset up an easy to access one-stop-shop referral pointwhere residents can access advice and support on arange of issues including health matters, finance andenergy saving. The service has operated in Islingtonsince December 2010 and up to the end of October2013 has processed over 4,150 referrals with 19,100interventions and resident savings on energy billsexceeding £455,00010.


The Chartered Institute of Environmental Healthwill work specifically with Public Health Englandand other partners and continue to stimulate,support, gather and disseminate good practice inenvironmental health aspects of deliveringsustainable development strategies andprogrammes in local government and business.

NHS England supports high quality care for all,now and for future generations. As such NHSEngland encourages the collaborative approach tosustainable development highlighted in this strategyand supports the principles by working to alignthese into existing thinking and processes.

JSNAs HWBB reportsHealth and

Wellbeing Strategies

Sustainability as an identifiable component of local plans

1. Board approved plan

2. Measure, monitor and report

3. Evaluation

4. Engage staff, service users and the public

• Sustainable Development Management Plan (or equivalent)including carbon reduction, adaptation plans and actions acrossthe sustainability agenda

• Statement of progress and action on sustainable development and adaption performance with recognisable core standard figures in annual report

• Evaluation, for instance with the Good Corporate Citizenship self assessment tool, to ascertain areas of strengths and opportunities for development

• Engagement with public, patients, clients and staff to help understand and support the development of a more sustainable and resilient health and care system

Organisation:

Public Health England will support action for sustainable development across the health and care system bycollecting, synthesising and sharing information about the health impacts of environmental and social changeand the most effective actions which can be taken to address these. Public Health England will use this toinform the evidence based practical assistance we will provide to local partners.

Organisational contributions NHS, public health and social care organisations can consider the following approach to support their assurance inmeeting legal, regulatory and policy requirements.


Network of sub-national and local sustainability leadsA network of sub-national and local leads across the health, care and public health systems link local champions,networks, and examples of good practice. This accelerates system-wide progress and supports implementation at a locallevel. This group identifies and shares best practice, innovation and learning locally both across and between local andsub-national networks. It provides an important communication channel between local action and national policy,facilitating a timely and effective spreading of best practice.

Guidance documents and tools Guidance, frameworks and tools are being updated to support individuals, organisations and local systems to makeprogress and share good practice. Guidance and tools accompanying this strategy:• Implementation notes with a menu of options for organisations and local systems5

• Carbon footprinting reports11

• Guidance to develop Sustainable Development Management Plans12

• Guidance to develop Adaptation Plan component of Sustainable Development Management Plans13

• Good Corporate Citizenship assessment tool14

• Adaptation Toolkit for the health and care sector to be developed and published by the Environment Agency’s ClimateReady support service early 201415.

Health sector report on adaptation to climate change Under the Adaptation Reporting Power provisions outlined in the Climate Change Act (2008) the government havenominated the Sustainable Development Unit with support from NHS England and Public Health England as the reportingauthority for the health and care sector16. A report on adaptation of the health and care sector to a changing climate willbe submitted in summer 2015.

Sustainable development considered in all policies, strategies and plansSustainable development principles, actions and measurements can be included as an integral part of all policies, strategiesand plans, and ultimately become a normal and accepted part of the leadership and organisational culture in every team,department, organisation and local system.

For example, sustainable development and carbon reduction principles and actions can be embedded in business casetemplates, tenders and contracts, HR processes and as part of impact assessments.

"NICE guidance is designed to help health and social care to get the best outcomes forpatients. We recognise the importance of environmental sustainability and so we encourageresearch into the environmental impact of prevention and healthcare interventions whichwe will take into account in the development of our guidance in the future. With moreconsistent measures of environmental impact, we hope in future to produce guidance thatwill improve the quality of care and the health of current and future populations by takinginto account the use of environmental as well as financial resources"

David Haslam - ChairNational Institute for Health and Care Excellence


Promoting a healthy lifestyle

Be Active is a scheme provided free of charge to all residents living in the Birmingham City Council area. The schemetackles health inequality and associated deprivation levels by offering access to free physical activity sessions for all 1.1 million citizens of the city. Participants can take part in free swimming, exercise classes or the gym at any Council-runleisure centre during off-peak hours. Funded through a partnership between Birmingham City Council and the local NHSthere are over 375,000 people now registered. Within the scheme there is a GP referral exercise programme for peoplewith long term medical conditions called Be Active Plus. Around 2,000 people a year are referred for a twelve weekprogramme of activity with a trained Health and Fitness Advisor17.

“Economic, social and environmental sustainabilityare key components of a health sector that worksin the interests of patients”

Toby Lambert - Director of Strategy and PolicyMONITOR


As a minimum, the Strategy needs to ensure the health and care system meets the Climate Change Act and related legalrequirements. At its best, it needs to ensure that the health and care system is a visible and empowering example intaking sustainable development forward.

Everyone served by the NHS, public health and social care system can benefit from these highly achievable aims:1. Reduced environmental impact: meet or exceed the target of a 34% reduction CO2e emissions by 2020. This would

leave the system well placed to meet the 50% target by 2025.2. Prepared communities: organisations and local communities can be well prepared for the impacts of climate change and

have plans in place to deal with events such as heatwaves, flooding and cold snaps. Progress will be highlighted in theSustainable Development Unit report on adaptation for the health and care sector under the Adaptation ReportingPower16 as well as a series of actions set out in the National Adaptation Programme18 published in July 2013.

3. Local community leadership: Health and Wellbeing Boards can develop strong and proactive Health and WellbeingStrategies within new and existing services that integrate the principles of sustainable development to achieve publichealth and sustainable development outcomes and can be reviewed on a regular basis.

4. Embedding sustainability: decision making processes can take account of sustainability in purchasing, investment,operational and strategic decisions, influencing the behaviour of those both inside and outside of the health and caresystem.

5. Improved health outcomes: measurable progress is made against national NHS, Public Health and Social Care OutcomesFrameworks19.

6. Recognition and replication: the public can be proud of our efforts made at a community level; we can truly benefitfrom the changes, and we can carry that experience into other areas.

What does success look like in 2020?

“Recordnumbers

livingwith

long-termconditions”“Dementia

time-bomb”

“The climateis changing”

“A time of austerity”

“Obesityepidemic” “Finite planetary

resources”


Context

Principle 6 - NHS

Constitution

Marmot Review 2010

GovernmentBuying

Standards

Economics ofClimate Change - Stern Review

2006

Health SectorReport on

Adaptation for2015

Defra Economics of ClimateResilience

Report 2013

NationalAdaptationProgramme

Health Co-benefitsEvidence

SustainableDevelopment

Unit Ipsos MORISurveys

Health andSocial CareCarbon footprint

Inter-governmental

Panel on ClimateChange AR 5

2013

Public HealthOutcomeFramework

EU Directive onPublic

Procurement

NHS StandardContract SDrequirements

Public Services(Social Value)Act (2012)

WHO Europe -Social

Determinantsand the Health

Divide

HPA HealthEffects ofClimate

Change 2012

HM TreasurySustainabilityReportingFramework

CivilContingenciesAct (2004)

Climate Change Act

(2008)

NICE Guidelines -Active Travel

NHS CarbonReduction

Strategy 2009

Health 2020WHO

NHS MarginalAbatement Cost Curves

National Policyand PlanningFramework

Challengingfinancial

environment

Rising costsand economic

context

The health and wellbeing challenges facing society require new ways of thinking and acting.

Adopting the sustainable development goals of valuing the environment, enabling people and places to be resilient andtaking every opportunity to maximise health and well-being can help support this transformation.

Work to achieve service integration, place based approaches, outcomes based commissioning, self-care, enablement andprimary prevention are taking place across the country to design economically sustainable solutions. We should all beaware of what initiatives are under way in our locality and be connecting with them.

Knowing about and aligning these solutions with environmental and social sustainability will reinforce more significant costsavings and health improvements.

These challenges have led to increasing support for a sustainable development approach. The key drivers for change canbe found in the diagram below. A brief explanation of each driver can be found on the Sustainable Development Unitwebsite20.

Key drivers for change – Including legislative, policy and other drivers for change


The public clearly believe it is important to use the planet’s resources in a way that minimises the negative impact on thewellbeing of others and on the environment.

In public opinion surveys undertaken by Ipsos MORI for the Sustainable Development Unit in November 2011 and again inSeptember 2013 close to 90% of respondents felt it was fairly or very important that the health and care system shouldmake sustainability a part of the way it does its work in the future.

Thirty six per cent of the respondents said the health and care system should act in a more sustainable way even if it wouldcost more money. Nineteen percent felt sustainability should be a top priority.

Full details of the surveys can be found on the Sustainable Development Unit website21.

The public’s views


A four month consultation and engagement process with organisations in the health and care system from 29 January to31 May 2013 received close to 1000 responses. Fifty five per cent of all NHS Trusts, 35% of all CCGs and 31% of all LocalAuthorities in England contributed to this process. • 94% of respondents agreed a strategy for sustainable development is needed to coordinate and guide the next phase

of action to 2020• 91% of respondents felt the health and care system should set itself challenging ambitions with regard to sustainability • Over 75% of respondents agreed that health and care should aim to be a leading public sector sustainable and low

carbon system• Over 75% of respondents agreed or strongly agreed that all the elements of the health and care system should be

included in the scope of the strategy.

The level of organisational engagement and responses highlighted how many organisations are already engaged indeveloping more sustainable and resilient systems and their wish to broaden this agenda across communities and inpartnership with others.

For additional information on the consultation and engagement process and to see the published summary of responsesplease visit the Sustainable Development Unit website22.

The system’s views


Understanding the impacts that services make on the environment is key to valuing natural resources. Carbon emissionsare the best currently recognised measure of this. The carbon footprint of the NHS, public health and all local authoritycommissioned and provided adult social services in England is estimated at 32 million tonnes of carbon dioxide equivalent(MtCO2e) in 2012, representing 40% of public sector emissions in England.

The Climate Change Act 200823 requires a reduction in emissions of 80% by 2050 based on a 1990 baseline, supportedby reductions of 34% by 2020 and 50% by 2025. The graph shows all carbon emissions from 1990 to 2012 withprojections to 2025.

The UK targets have been applied to emissions from building energy use, travel and procurement of goods and services.

For additional information on the carbon footprint data please visit the Sustainable Development Unit website24.

Carbon footprint of the NHS, Public Health and Social Caresystem

An ambitious aspiration for the health and care system is to achieve a 34% reduction in carbondioxide equivalent emissions from building energy use, travel and procurement of goods andservices by 2020.

Trajectory wedge

Health and Social Care England Carbon FootprintCO2e baseline from 1990 to 2025 with Climate Change targets

Trajectory to 2020

28% from 2013 and 34% from 1990

HSC System England forecast

Climate Change Act Trajectory

HSC System England GHG emissions

2013 baseline

1990 baseline

64% Target from 1990 baseline



1990 20201995 2000 2005

Year

2010 2015 2025 2030 2035 2040 2045 2050

Mt

CO

2e

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.001997 2004 2010 2015 2020


The NHS, public health and social care system recognises that the current system is not sustainable without radicaltransformation. It highlights that environmental and social sustainability can be addressed alongside economicsustainability challenges.

This strategy has been developed following a robust consultation and engagement process with collaboration from allparts of the health and care system. Two public surveys indicate there is also support from the public.

This strategy proposes the vision that a sustainable system protects and improves health within environmental and socialresources now and for future generations. This means reducing carbon emissions, minimising waste and pollution, buildingresilience to climate change and nurturing community strengths.

Three goals have been identified to support this vision:1- A healthier environment2- Communities and services are resilient to changing times and climates3- Every opportunity contributes to healthy lives, communities and environments.

A sustainable approach is proposed that builds on the virtuous cycles of reducing environmental impact whilst enhancingthe natural environment. This means reducing inequalities whilst building on social assets and reducing the burden ofdisease whilst supporting independence and wellbeing. This applies to both people and places.

Five modules support the main document and provide further information on key areas of focus: leadership andengagement, models of care, local communities, carbon hotspots, and commissioning and procurement.

Three further modules will be developed and launched in January 2015: technology and research, metrics and socialcapital.

The strategy encourages implementation at a local level where health and wellbeing boards play a key role through theirneeds assessments and strategies.

Organisations can ensure they contribute by having a board approved sustainable development plan, measuring andreporting on progress, evaluating their approach and engaging with staff, service users and the public.

A cross system advisory group is in place to support the process at a national level and a network of local and regionalleads are providing support at a local level. Further guidance and tools will be developed to support the system and everypolicy could include environmental and social sustainability considerations.

The Sustainable Development Unit will coordinate the writing of an adaptation report as part of the July 2015 AdaptationReporting Power request. This will provide a further opportunity to highlight and support communities and services to beprepared for adverse weather events and climate change.

Key success measures identified for 2020 will be monitored by the Sustainable Development Unit and the National CrossSystem Advisory Group.

This includes a reduction of the carbon footprint by 34% by 2020. In 2012 the footprint of the health and care systemwas 32 Million tonnes CO2e which represents 40% of the public sector in England.

Further information and implementation notes are available at www.sduhealth.org.uk

Executive summary


‘I’m delighted to see the emergence of a newsustainable development strategy for the healthand care system. This represents the full breadthof what sustainability means today, and perfectlyexemplifies the huge potential that now exists toenhance the lives of individuals and the health ofcommunities.’

Jonathon Porritt- Founder DirectorForum for the Future


@UK PLCAcademy of Medical Royal CollegesAdaptation and Resilience to a Changing Climate CoordinationNetwork (ARCC CN)

Airedale NHS Foundation TrustAssociation of Chartered Certified AccountantsAssociation of Directors of Public HealthAssociation of the British Pharmaceutical IndustryAudit & Finance Non-Executive Director Forum (AFNED)Azure PCR LtdBarking, Havering & Redbridge University Hospitals NHS TrustBarnet & Chase Farm NHS TrustBarnsley CouncilBarnsley's Health and Wellbeing BoardBarts Health NHS TrustBaxterBedford Hospital NHS TrustBerkshire Healthcare Foundation TrustBirmingham and Solihull Mental Health NHS Foundation TrustBirmingham Community Healthcare NHS TrustBirmingham Women's NHS Foundation TrustBracknell Forest CouncilBradford Teaching Hospitals NHS Foundation TrustBrighton and Sussex University Hospitals NHS TrustBristol City Council & Bristol Public Health Bristol Green Capital sustainable health group.British Association for Community Child HealthBritish Medical AssociationBuckinghamshire County CouncilBuilding Research Establishment Ltd.Cambridge University Hospitals NHS Foundation TrustCampaign for Better Hospital FoodCarbon TrustCare Plus GroupCare Quality CommissionCare UK LtdCarillion PLCCatherine Max Consulting: The Future Health PartnershipCentral London Community Healthcare NHS TrustCentral Manchester University Hospitals Foundation TrustCentre for Sustainable HealthcareCheshire and Wirral Partnership NHS Foundation TrustCheshire West and Chester Council Health and Wellbeing BoardChristchurch Hospital, New Zealand

City Of Bradford Metropolitan District CouncilClimate and Health CouncilClimate UKCO2Sense CICCollaboration for Leadership in Applied Health Research andCare, Nottinghamshire, Derbyshire and LincolnshireCommunity Solutions partnership Services LtdCornwall Council - Cornwall Health Environment CommitteeCountess of Chester Hospital NHS Foundation TrustCounties Manukau Health, New ZealandCounty Durham and Darlington NHS Foundation TrustCroydon CouncilCumbria Partnership NHS Foundation TrustDartford & Gravesham NHS TrustDepartments of Public Health - Nottingham City Council &Nottinghamshire County CouncilDerby City Council Health and Wellbeing BoardDerby Hospitals NHS Foundation TrustDerbyshire Community Health Services NHS TrustDerbyshire Healthcare NHS Foundation TrustDevon Partnership NHS TrustDoncaster CouncilDorset Public HealthDudley & Walsall Mental Health Partnership NHS TrustDurham County CouncilEast & North Herts NHS TrustEast Kent Hospitals University Foundation TrustEast Lancashire Hospitals NHS TrustEast Midlands LETBEast Midlands NHS SD NetworkEast of England Ambulance ServiceEast Sussex Healthcare NHS TrustEddie StobartEnvironment AgencyFaculty of Medical Leadership and Management Fay Blair AssociatesFood for Life PartnershipForum for the FutureFoundation Trust NetworkFriends of the EarthFrimley Park Hospital NHS Foundation TrustGeorge Eliot Hospital NHS TrustGhent UniversityGloucestershire Care Services NHS Trust

Contributors

Through the development of this strategy many forward thinking organisations and individuals have added thought andcredence to the strategy development process. We would like to thank everyone for the time and effort that they have sogenerously given to this process.

The following organisations, groups and networks were part of the consultation and engagement process which informedthe development of this strategy:


Gloucestershire Hospitals NHS Foundation TrustGreater Manchester West, Mental Health NHS Foundation TrustGreener JourneysGrowing in HaringeyGuy’s and St Thomas’ NHS Foundation TrustHalton Borough Council Health and Wellbeing BoardHampshire Health and Wellbeing BoardHampshire Hospitals NHS Foundation TrustHarrogate and District NHS Foundation TrustHealth Education EnglandHealth Estates and Facilities Management Association Health in BalanceHealthwatch DerbyHealthwatch HertfordshireHealthy Planet UK Hertfordshire County Council - Public Health DirectorateHounslow and Richmond Community Healthcare NHS TrustHull and East Yorkshire Hospitals NHS TrustHull City CouncilHumber NHS Foundation TrustImperial College Healthcare NHS TrustIsle of Wight NHS TrustJohnson & JohnsonJoseph Rowntree FoundationKettering General Hospital NHS Foundation TrustKirklees Council - Green InfrastructureLancashire Care NHS Foundation TrustLancashire Teaching Hospital NHS Foundation TrustLeeds Teaching Hospitals NHS TrustLeicester City CouncilLeicestershire County CouncilLewisham Healthcare NHS TrustLincolnshire County Council Health and Wellbeing BoardLincolnshire Partnership NHS Foundation TrustLiverpool City Council - Public Health DirectorateLiverpool City Region Local Nature PartnershipLiverpool Community Health NHS TrustLiverpool Heart & Chest HospitalLiverpool NHS Carbon CollectiveLiving StreetsLiving With Environmental Change (LWEC)London Borough of Havering Health and Wellbeing BoardLondon Borough of MertonLondon Borough of Richmond upon Thames CouncilLondon Climate Change PartnershipLondon Cycling CampaignLuton & Dunstable HospitalLuton Borough CouncilLuton Borough Council (Public Health)Maidstone And Tunbridge Wells NHS TrustManchester Mental Health and Social Care TrustMarie CurieMedsin

Medway NHS Foundation TrustMid Cheshire Hospitals NHS Foundation TrustMid Essex Hospital Services NHS TrustMid Yorkshire NHS Trust MonitorMoorfields Eye Hospital NHS Foundation TrustNational Institute for Health and Care ExcellenceNatural Interest Ltd.NEP Energy Services LtdNewcastle Upon Tyne Hospitals NHS Foundation TrustNHS Airedale Wharfedale and Craven CCGNHS AllianceNHS Barnsley CCGNHS Birmingham South Central CCGNHS Blood and TransplantNHS Bradford City CCGNHS Bradford District CCGNHS Brighton and Hove CCGNHS Bristol CCGNHS Bromley CCGNHS Cambridgeshire and Peterborough CCGNHS Cannock Chase CCGNHS Central Southern CSUNHS Cheshire and Merseyside CSUNHS Chorley and South Ribble CCGNHS City and Hackney CCGNHS Coastal West Sussex CCGNHS ConfederationNHS Coventry and Rugby CCGNHS Crawley CCGNHS Darlington CCGNHS Dartford, Gravesham and Swanley CCGNHS DirectNHS Doncaster CCGNHS Dorset CCGNHS Durham Dales, Easington and Sedgefield CCGNHS East Lancashire CCGNHS East Leicestershire and Rutland CCGNHS East Staffordshire CCGNHS EnglandNHS EmployersNHS Erewash CCGNHS Fareham & Gosport CCGNHS Gloucestershire CCGNHS Great Yarmouth and Waveney CCGNHS Greater East Midlands CSUNHS Greater Preston CCGNHS Hartlepool and Stockton-on-Tees CCGNHS Herts Valleys CCGNHS High Weald Lewes Havens CCGNHS Horsham and Mid Sussex CCGNHS Kernow CCGNHS Leadership Academy


NHS Leeds North CCGNHS Leeds South and East CCGNHS Leicester City CCGNHS Lincolnshire East CCGNHS Liverpool CCGNHS Merton CCGNHS Milton Keynes CCGNHS National Performance Advisory Group (NPAG)Sustainability Best Value Group

NHS Nene CCGNHS North East Essex CCGNHS North East Lincolnshire CCGNHS North Norfolk CCGNHS North Somerset CCGNHS North West London CSUNHS North West Surrey CCGNHS North Yorkshire and Humber CSUNHS North, East, West Devon CCGNHS Northumberland CCGNHS Norwich CCGNHS Nottingham North and East CCGNHS Nottinghamshire CountyNHS Portsmouth CCGNHS Property Services - EssexNHS Property Services Ltd. NHS Somerset CCGNHS South East Staffordshire and Seisdon Peninsula CCGNHS South Eastern Hampshire CCGNHS South Kent Coast CCGNHS South London CSUNHS South Manchester CCGNHS South Sefton CCGNHS South West CSUNHS South West Lincolnshire CCGNHS Southern Derbyshire CCGNHS Southport & Formby CCGNHS Stafford & Surrounds CCGNHS Supply ChainNHS Swale CCGNHS Thanet CCGNHS Tower Hamlets CCGNHS Wakefield CCGNHS Wandsworth CCGNHS West and South Yorkshire and Bassetlaw CSUNHS West Hampshire CCGNHS West Lancashire CCGNHS West Norfolk CCGNHS Wigan Borough CCGNHS Wiltshire CCGNorfolk and Suffolk Foundation NHS TrustNorfolk Community Health & Care NHS TrustNorfolk County CouncilNorfolk County Council - Network of Green party Councillors and members in mid-Norfolk

North Bristol TrustNorth Cumbria University Hospitals NHS TrustNorth East Lincolnshire CouncilNorth East London NHS Foundation Health TrustNorth Tees & Hartlepool NHS Foundation TrustNorth Tyneside CouncilNorth West Ambulance Service NHS TrustNorth West London Hospitals TrustNorth West London NHS Property ServicesNorthampton General HospitalNorthamptonshire Healthcare NHS Foundation TrustNorthern Lincolnshire and Goole Hospitals NHS Foundation TrustNorthumberland County CouncilNorthumberland Tyne & Wear NHS Foundation TrustNorthumbria Healthcare NHS Foundation TrustNottingham University Hospitals NHS TrustNottinghamshire Healthcare NHS TrustNovo Nordisk A/SOxford Health NHS Foundation TrustPatients Know BestPeterborough City CouncilPharmaceutical Services Negotiating CommitteePhysiotherapy Matters LimitedPirates are Cooler than NinjasPlymouth Hospitals NHS TrustPlymouth UniversityPopulation MattersPortsmouth Hospitals NHS TrustPublic Health CornwallPublic Health EnglandPublic Health England Centre - Cumbria and LancashirePublic Health England Centre - East Midlands Public Health England Centre - West MidlandsPublic Health SuffolkRedcar and Cleveland CouncilResilient CommunitiesRotherham NHS Foundation TrustRotherham, Doncaster and South Humber NHS Foundation TrustRoyal Borough of Greenwich CouncilRoyal College of AnaesthetistsRoyal College of General PractitionersRoyal College of MidwivesRoyal College of NursingRoyal College of Obstetricians and Gynaecologists Royal College of OphthalmologistsRoyal College of Paediatrics and Child HealthRoyal College of Physicians of LondonRoyal College of PsychiatristsRoyal Liverpool & Broadgreen University Hospitals NHS TrustRoyal Orthopaedic Hospital NHS Foundation TrustRoyal Pharmaceutical SocietyRoyal Society for Public Health


Royal United Hospital Bath NHS TrustRutland Health and Wellbeing BoardSalford Royal NHS Foundation TrustSalix FinanceSandwell & West Birmingham Hospitals NHS TrustSocial Care in Action (SCA)School of Pharmacy Keele UniversityScottish Managed Sustainable Health Network (SMaSH)Scottish Public Health Network (ScotPHN)Sefton Council Health and Wellbeing BoardShared Lives PlusSheffield Children’s NHS Foundation TrustSheffield City CouncilSheffield Health & Social Care NHS Foundation TrustShrewsbury & Telford Hospital NHS TrustShropshire Community Health TrustSocial Care Institute for ExcellenceSolent NHS TrustSolent Supplies TeamSouth Central Ambulance Service NHS Foundation TrustSouth East Coast Ambulance NHS Foundation TrustSouth Essex Partnership University NHS Foundation TrustSouth London & Maudsley NHS Foundation TrustSouth Tyneside NHS Foundation TrustSouth West Yorkshire Partnerships Foundation TrustSouthend University Hospital NHS Foundation TrustSouthern Health NHS Foundation TrustSouthwark CouncilSt Helens and Knowsley Hospitals NHS TrustSt Monica TrustStaffordshire and Stoke on Trent Partnership TrustStaffordshire County Council Health and Wellbeing BoardStockport County Council Health and Wellbeing BoardStockport NHS Foundation TrustSue Ryder FoundationSunderland City Council Health and Wellbeing BoardSurrey and Borders Partnership NHS Foundation TrustSurrey County Council Health and Wellbeing BoardSussex Community NHS TrustSussex Partnership NHS Foundation TrustSustainability Indicators Metric Group - SDU ledSustainable Travel Solutions LtdSustenance and The Green Gardeners GroupSustransTameside Hospital NHS Foundation trustTanzania Poverty Reduction SocietyTaunton and Somerset NHS Foundation TrustTees, Esk and Wear Valleys NHS Foundation TrustThe British Dental Trade AssociationThe Christie NHS Foundation TrustThe Forge ClinicThe Green Health ConsultancyThe Hillingdon Hospitals NHS Foundation TrustThe King's Fund

The Mersey ForestThe Patients AssociationThe Princess Alexandra Hospital NHS TrustThe Public Health Registrar Sustainable Development NetworkThe Robert Jones and Agnes Hunt Orthopaedic Hospital NHSFoundation Trust

The Tavistock and Portman NHS Foundation TrustThird Sector Assembly Cheshire WestTWI LtdUK Faculty of Public HealthUK Health ForumUniversity College London Hospitals (UCLH) NHS Foundation TrustUniversity Hospital of North Staffordshire NHS TrustUniversity Hospital South ManchesterUniversity Hospitals Birmingham NHS Foundation TrustUniversity Hospitals Bristol NHS Foundation TrustUniversity Hospitals Coventry and Warwickshire NHS TrustUniversity of BrightonUniversity of YorkUscreatesWakefield Health and Wellbeing BoardWaldron Office Furniture Ltd.Waltham Forest Council Health and Wellbeing BoardWarrington and Halton Hospitals NHS Foundation TrustWarrington Borough Council - Public HealthWest London Mental Health NHS TrustWest Midlands Ambulance Service NHS Foundation TrustWest Suffolk Foundation NHS TrustWestern Sussex Hospitals NHS TrustWeston Area Health NHS TrustWhittington Health NHS TrustWHO Collaborating Centre for Healthy Cities and Urban PolicyWillmott DixonWirral Community NHS TrustWirral University Teaching Hospital NHS Foundation TrustWRAPWrightington, Wigan and Leigh NHS Foundation TrustWRM Sustainability LtdWye Valley NHS TrustYeovil District Hospital NHS Foundation TrustYork Teaching Hospital NHS Foundation TrustYorkshire Ambulance Service NHS TrustYoung Fabians


Asset: a useful or valuable thing or person. In relation tocommunity assets we mean valuable things and peoplewithin that community such as local sports teams, localcharities, a strong sense of community spirit or localvolunteers. Environmental assets could include things suchas green spaces, areas that encourage biodiversity, lakesand rivers or natural resources.

Carbon: Throughout this strategy the word carbon is usedas a generic term for carbon dioxide equivalent emissions(CO2e), otherwise known as greenhouse gases.

Climate Change Act: The Climate Change Act (2008) wasintroduced to ensure the UK cuts its carbon emissions by80% by 2050 (against a 1990 baseline) and to ensure thatthe Government’s programme for adaptation enables theUK to prepare effectively for the impacts of climate change.

Co-benefits: Actions that have benefits across two or moreareas. For example: more walking and cycling and drivingyour car less, is good for health (all the health benefits ofphysical activity) and good for the environment (less carbonemissions, less air and noise pollution).

CO2e: carbon dioxide equivalent. It is a way of measuringsix different greenhouse gases using one standard unit bycomparing them on a like for like basis relative to one unitof carbon dioxide (CO2). The six greenhouse gases are:carbon dioxide; hydrofluorocarbons; methane; nitrousoxide; perfluorocarbons and sulphur hexafluoride.

Place based approaches: A whole area approach to thedesign and delivery of public services.

Glossary


1 NHS England, 2014. NHS England Call to Action [online] Available at: www.england.nhs.uk/ourwork/qual-clin-lead/calltoaction/ [Accessed 06 January 2014]

2 World Health Organization, 1948. WHO Definition of Health [Online] Available at: www.who.int/about/definition/en/print.html [Accessed 06 January 2014]

3 Department of Environment, Food, and Rural Affairs, 2011. Sustainable Development in Government. Guiding principles for sustainable development[Online] Available at: http://sd.defra.gov.uk/what/principles/ [Accessed 06 January 2014]

4 Building Better Healthcare, 2013. Building Better Healthcare 2012 Winners’ Book. Sustainability Class pg. 17 [Online] Available at: www.willmottdixongroup.co.uk/assets/b/u/building-better-health-awards-writeup-2012-nov.pdf [Accessed 06 January 2014]

5 Sustainable Development Unit, 2014. Areas of Focus [Online] Available at: www.sduhealth.org.uk/focus [Accessed 06 January 2014]

6 Department of Health, 2011. Joint Strategic Needs Assessment and joint health and wellbeing strategies explained. [Online] Available at: www.gov.uk/government/publications/joint-strategic-needs-assessment-and-joint-health-and-wellbeing-strategies-explained [Accessed 06 January 2014]

7 Kings Fund, 2013. Health and wellbeing boards. One year on. pg.11 [Online] Available at: www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/health-wellbeing-boards-one-year-on-oct13.pdf [Accessed 06 January 2014]

8 Marmot, M. 2010. Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post 2010 [Online] Available at: www.instituteofhealthequity.org/Content/FileManager/pdf/fairsocietyhealthylives.pdf [Accessed 06 January 2014]

9 Kent County Council, 2013. Joint Strategic Needs Assessment: A Guide to Integrating Sustainability [Online] Available at: www.sduhealth.org.uk/resilience [Accessed 06 January 2014]

10 Islington, 2014. SHINE Referral Scheme [Online] Available at: www.islington.gov.uk/services/parks-environment/sustainability/sus_awarmth/Pages/shine.aspx [Accessed 06 January 2014]

11 Sustainable Development Unit, 2014. Carbon Footprint Reports [Online] Available at: www.sduhealth.org.uk/report [Accessed 06 January 2014]

12 Sustainable Development Unit, 2014. Sustainable Development Management Plan (SDMP) Guidance. [Online] Available at: www.sduhealth.org.uk/plan [Accessed 06 January 2014]

13 Sustainable Development Unit, 2014. Adaptation to Climate Change. Planning Guidance for Health and Social Care Organisations [Online] Available at: www.sduhealth.org.uk/plan [Accessed 06 January 2014]

14 Sustainable Development Unit, 2012. Good Corporate Citizenship (GCC) Tool [Online] Available at: www.sduhealth.org.uk/gcc/ [Accessed 06 January 2014]

15 Environment Agency, 2014. Adaptation Toolkit for the health and care system [Online] Available at: www.sduhealth.org.uk/resilience [Accessed 06 January 2014]

16 Department of Environment, Food, and Rural Affairs, 2013. Adapting to Climate Change: Ensuring Progress in Key Sectors. 2013 Strategy for Exercising theAdaptation Reporting Power and list of priority reporting authorities [Online] Available at: www.gov.uk/government/uploads/system/uploads/attachment_data/file/209875/pb13945-arp-climate-change-20130701.pdf[Accessed 06 January 2014]

17 Birmingham City Council, 2014. Be Active Plus [Online] Available at: www.birmingham.gov.uk/beactiveplus [Accessed 06 January 2014]

18 Department of Environment, Food, and Rural Affairs, 2013. Policy - Adapting to climate change [Online] Available at: www.gov.uk/government/policies/adapting-to-climate-change/supporting-pages/national-adaptation-programme [Accessed 06January 2014]

19 Department of Health, 2013. Health and social care outcomes frameworks [Online] Available at: www.gov.uk/government/collections/health-and-social-care-outcomes-frameworks [Accessed 06 January 2014]

20 Sustainable Development Unit, 2014. Key drivers for change [Online] Available at: www.sduhealth.org.uk/sds [Accessed 06 January 2014]

21 Ipsos MORI, 2011 & 2013. Public Opinion [Online] Available at: www.sduhealth.org.uk/report [Accessed 06 January 2014]

22 Sustainable Development Unit, 2013. Summary of Responses to the Consultation on a Sustainable Development Strategy for the Health, Public Health andSocial Care System 2014-2020. [Online] Available at: www.sduhealth.org.uk/sds [Accessed 06 January 2014]

23 HMSO, 2008 Climate Change Act 2008 (c.27) [online] Available at: www.legislation.gov.uk/ukpga/2008/27/pdfs/ukpga_20080027_en.pdf [Accessed 06 January 2014]

24 Sustainable Development Unit, 2014. NHS, Public Health and Social Care Carbon Footprint 2012. [Online] Available at: www.sduhealth.org.uk/report[Accessed 06 January 2014]

References

The Sustainable Development UnitVictoria House, Capital Park, Fulbourn, Cambridge, CB21 5XB

T: 0113 8253220 E: [email protected]: www.sduhealth.org.ukFollow us on Twitter - @sduhealth This publication is printed on 100% recycled paper and is printed using vegetable-based inks and a water-based sealant.

Designed and produced by: MJWebb Associates Ltd

Published January 2014

Document produced by the Sustainable Development Unit (SDU) which is funded by, and accountable to, NHS England and Public Health England towork across the NHS, public health and social care system.

The SDU supports the NHS, Public Health and Social Care system to be sustainable environmentally and socially. This is done by engaging across thesystem to identify the frameworks, networks and mechanisms that will encourage a healthier environment, better health and enable communities andservices to be resilient to adverse weather events and climate change.

Responsibility for the content of this document lies with the Sustainable Development Unit.

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